Bone cut guide apparatus and method

ABSTRACT

A bone cut guide includes a first portion having a first cut slot and having an aperture for receiving a wire to connect the first portion to a first bone. A second portion has a second cut slot and a second aperture for receiving a second wire to connect the second portion to a second bone. The first portion and the second portion are movably connected to each other to allow the first bone and the second bone to move relative to each other.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application claims priority to U.S. Provisional ApplicationNo. 62/900,920 filed on Sep. 16, 2019, U.S. Provisional Application No.62/991,879 (Attorney Docket No. 3768.094P1) filed Mar. 19, 2020, andU.S. Provisional Application No. 63/015,052 (Attorney Docket No.3768.099P1) filed Apr. 24, 2020, which are incorporated herein byreference in their entirety.

BACKGROUND Field of the Invention

This application relates to apparatuses, devices, and methods foradjusting and joining bones.

Description of the Related Art

Hallux valgus is the medical term for a bunion. The firsttarsal-metatarsal (TMT) joint is an important joint at the inner part ofthe middle of the foot. The two bones that meet to form this joint arethe first metatarsal and medial cuneiform bones. When this joint has toomuch looseness or movement, the condition is known as hypermobility orinstability. When this joint becomes hypermobile, the first metatarsalmoves too much in one direction and the first toe compensates by movingtoo much in the other direction. When this happens, a bunion develops.

The bunion is a disease of the joint and soft tissue. A bunion deformityor hallux abducto valgus deformity results from the big toe deviatinglaterally toward the patient's smallest toe. Due to the lateral movementof the big toe, the first metatarsal bone angles toward the smaller toeson the patient's foot causing the first metatarsal bone to move out ofalignment. Bunions may become irritating and, in some cases, verypainful during walking and other weight bearing activities. Bunions mayalso be painful and debilitating condition that prevents wearing shoes.Genetics and poor shoe design are the causes. The angle between themetatarsal of the second digit is a means to quantify the degree ofdeformity.

Painful bunions are corrected by surgical soft tissue management andsurgical bone reforming. The first metatarsal is corrected by sectioningit with a saw and moving the head laterally. There are numerous cutlocations from the proximal to distal regions, namely the chevron,Ludloff, Mau and proximal. The bones are shifted, and held in place withscrews, staples or plates. Sometimes adjacent joints are fused tostabilize the reconstruction.

The Lapidus procedure is a type of fusion of the first TMT joint thatdecreases the movement of that joint and straightens out the firstmetatarsal and toe, so the Lapidus procedure treats bunions caused byfirst TMT joint hypermobility.

The goal of the Lapidus procedure is to surgically treat hallux valgusthat is caused by first TMT joint hypermobility. An orthopedic foot andankle surgeon realigns to a normal toe shape by placing the firstmetatarsal straight with the medial cuneiform bone and locking or fusingthese two bones together. When the first TMT joint is fused, the firstmetatarsal will not move abnormally. This will allow the first toe tostay straight and prevent the bunion from coming back.

There is thus a need for alternative designs for systems and methods forcutting and joining two bone pieces, including implants that fix the twobone pieces, particularly designs that allow adjustment of the angle offlexion between the two bones.

SUMMARY OF THE INVENTION

The present invention provides, in a first aspect, a bone cut guidewhich includes a first portion having a first cut slot and having anaperture for receiving a wire to connect the first portion to a firstbone. A second portion has a second cut slot and a second aperture forreceiving a second wire to connect the second portion to a second bone.The first portion and the second portion are movably connected to eachother to allow the first bone and the second bone to move relative toeach other.

The present invention provides, in a second aspect, a method for use inaligning bones which includes inserting a joint arm of a guide between afirst bone and a second bone. A first wire is inserted through a guideaperture of the guide into the first bone. The guide is removed and afirst portion of a bone cut guide is attached to the first bone byreceiving the wire in a first aperture of the bone cut guide andinserting the first wire in the first bone. A second portion of the bonecut guide is attached to a second bone by receiving a wire in a firstaperture of the bone cut guide and inserting the second wire in thesecond bone.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be understood more fully from the detaileddescription given hereinafter and from the accompanying drawings of thepreferred embodiment of the present invention, which, however, shouldnot be taken to limit the invention, but are for explanation andunderstanding only.

In the drawings:

FIG. 1 is a perspective view of an embodiment of a cut guide, inaccordance with an aspect of the present invention;

FIG. 2 is a top plan view of a wire guide engaging a bone;

FIG. 3 is a side view of a portion of the wire guide and bone of FIG. 2;

FIG. 4 is a perspective view of the cut guide of FIG. 1 being connectedto a first bone portion and a second bone portion;

FIG. 5 is a top plan view of the cut guide of FIG. 1 connected to thebone via one wire;

FIG. 6 is a top view of the cut guide of FIG. 5 with a second wireconnecting the cut guide to the bone;

FIG. 7 is a perspective view of the cut guide of FIG. 6 with a thirdwire connected to the second bone portion;

FIG. 8 is a top view of the cut guide of FIG. 7 showing an angle betweentwo metatarsals;

FIG. 9 is a top view of the cut guide of FIG. 8 with acompression-distraction portion thereof engaged to adjust an angle ofthe first and second metatarsals;

FIG. 10 is a top view of the cut guide of FIG. 9 with the first andsecond metatarsals aligned relative to each other in a desired position;

FIG. 11 is a top view of the bone cut guide of FIG. 10 in a position forcutting of first and second bone portions;

FIG. 12 is a schematic view of two bone portions removed as per the bonecut guide of FIG. 11;

FIG. 13 is a top view of a foot showing an angle of obliquity; and

FIG. 14 is a schematic view of two metatarsals in a corrected position.

Corresponding reference characters indicate corresponding partsthroughout the several views. The exemplary embodiments set forth hereinare not to be construed as limiting the scope of the invention in anymanner.

DETAILED DESCRIPTION OF THE EMBODIMENTS

The present invention will be discussed hereinafter in detail in termsof various exemplary embodiments according to the present invention withreference to the accompanying drawings. In the following detaileddescription, numerous specific details are set forth in order to providea thorough understanding of the present invention. It will be obvious,however, to those skilled in the art that the present invention may bepracticed without these specific details. In other instances, well-knownstructures are not shown in detail in order to avoid unnecessaryobscuring of the present invention.

Thus, all the implementations described below are exemplaryimplementations provided to enable persons skilled in the art to make oruse the embodiments of the disclosure and are not intended to limit thescope of the disclosure, which is defined by the claims. As used herein,the word “exemplary” or “illustrative” means “serving as an example,instance, or illustration.” Any implementation described herein as“exemplary” or “illustrative” is not necessarily to be construed aspreferred or advantageous over other implementations. Moreover, in thepresent description, the terms “upper”, “lower”, “left”, “rear”,“right”, “front”, “vertical”, “horizontal”, and derivatives thereofshall relate to the invention as oriented in FIG. 1.

The following description references systems, methods, and apparatusesfor cutting tools for orthopedic surgery involving a foot or lowerextremities. However, those possessing an ordinary level of skill in therelevant art will appreciate that other extremities, joints, and partsof the musculoskeletal system are suitable for use with the foregoingsystems, methods and apparatuses. Likewise, the various figures, steps,procedures and work-flows are presented only as an example and in no waylimit the systems, methods or apparatuses described to performing theirrespective tasks or outcomes in different time-frames or orders. Theteachings of the present invention may be applied to any orthopedicsurgery, such as on the hand as well as other upper and lowerextremities and may be implemented in other treatments sites that havesimilar anatomical considerations.

Furthermore, there is no intention to be bound by any expressed orimplied theory presented in the preceding technical field, background,brief summary or the following detailed description. It is also to beunderstood that the specific devices and processes illustrated in theattached drawings, and described in the following specification, aresimply exemplary embodiments of the inventive concepts defined in theappended claims. Hence, specific dimensions and other physicalcharacteristics relating to the embodiments disclosed herein are not tobe considered as limiting, unless the claims expressly state otherwise.

As depicted in FIGS. 1 and 4-11, a cut guide 100 is connected to a firstmetatarsal bone 122 and a medial cuneiform bone 121 by a plurality oflandmark guide wires or k-wires 130 inserted through a plurality ofholes or bores 108 extending through cut guide 100. Cut guidepositioning is depicted in relation to a second metatarsal bone 123. Cutguide 100 has a first member or cut guide body 104, a second member ormetatarsal cutting fixture or mobile metatarsal cutting portion 103, anarm 109 and a compress-distraction fixture 105.

Compression-distraction fixture 105 extends from second member 103 andengages with first member 104 along a linear track 115, with lineartrack 115 connected to first member 104. Linear track 115 has a threadedrack 107 on a lateral face and a track groove 112.Compression-distraction fixture 105 has a power screw or metatarsaladjustment screw 106. When power screw 106 is engaged and turned byscrewdriver 250, compression-distraction fixture 105 is translatablemovable along threaded rack 107 and within track groove 112.

Further referring to FIGS. 1 and 4-11, first member 104 has a first cutslot or proximal cuneiform cutting slot 101 and second member 103 has asecond cut slot or distal metatarsal cutting slot 102. Proximalcuneiform cutting slot 101 is elongated in the medial-lateral directionand narrow in the anterior-posterior direction. Proximal cuneiformcutting slot 101 extends through first member 104 in the dorsal-plantardirection. Distal metatarsal cutting slot 102 is a “U” shaped slot,elongated in the medial-lateral direction and narrow in theanterior-posterior direction. Distal metatarsal cutting slot 102 extendsthrough second member 103 in the dorsal-plantar direction. Proximalcuneiform cutting slot 101 and distal metatarsal cutting slot 102 areparallel.

With continued reference to FIGS. 1 and 4-11, second member 103 andcompression-distraction fixture 105 are connected and therefore both aretranslated, moving in an anterior-posterior direction relative to firstmember 104, when power screw 106 is turned. Proximal cuneiform cuttingslot 101 and distal metatarsal cutting slot 102 remain parallel under,and after, such translation.

With reference to FIGS. 2-3, a wire guide 200 has a body 203, a borehole 205, and an arm 201. Wire guide 200 is depicted with arm 201positioned within a joint space 202 of a joint 204 between medialcuneiform bone 121 and first metatarsal bone 122 (FIG. 1).

With reference to FIGS. 12-14, an angle of obliquity is depicted withfirst metatarsal bone 122 removed in FIG. 13, for use of illustration.First metatarsal bone 122 and a medial cuneiform bone 121 are depictedwith a first bone wedge 150 removed from first metatarsal bone 122, anda second bone wedge 151 removed from medial cuneiform bone 121 in FIG.12. A cuneiform cut 155 and a metatarsal cut 156 may be approximatelyparallel as depicted, for example, in FIG. 12. The resulting bonesurfaces (FIG. 14) after first bone wedge 150 and

{H1825167.1} 6 second bone wedge 151 have been removed may, for example,be planar surfaces or further machined to be planar surfaces. Bone wedge150 is depicted as having a thicker end and a thinner end, with thethicker end being bone removed from a lateral side of first metatarsalbone 122 and the thinner section being bone removed from a medial sideof first metatarsal bone 122. In another embodiment, a bone materialamount removed in second wedge 151 may be, for example, greater than abone material amount removed in first bone wedge 150.

With reference to FIGS. 1-11 wire guide 200 (FIGS. 2-3) and cut guide100 (FIGS. 1 and 4-11) are depicted for use in correcting the angle ofobliquity between metatarsal bones (e.g. first metatarsal bone 122) andcuneiform bones (e.g., medial cuneiform bone 121). In an example, arm201 of wire guide 200 is placed within joint space 202 to capturefeatures of the joint such as obliquity, peaks and valleys. Wire guide200 contains bore 205 for placing a landmark guide wire or a k-wire 131of k-wires 130 into a bone (e.g., medial cuneiform bone 121) that can beused as a reference. Wire guide 200 establishes an initial k-wireposition, and an inserted first k-wire (e.g., k-wire 131) is used toestablish a cut distance. At this point, if a cut angle is known, ablocking k-wire (not shown) may be inserted into the bone (e.g., firstmetatarsal 122) to establish cut distance and angle. The blocking k-wiremay be placed parallel to the first k-wire (e.g., outside guide 200 butparallel to a longitudinal dimension thereof) to stop rotation of guide200 about the installed k-wire (e.g., k-wire 131) in a direction towardthe second k-wire (not shown). However, if cut angle is yet to bedetermined, only one k-wire (e.g., k-wire 131) is used to allow rotationof guide 200. Selection of reference points for positioning cut guide100 may be selected to, for example, remove more bone material fromcuneiform bone 121 rather than from metatarsal bone 122.

With continued reference to FIGS. 1-11, wire guide 200 (FIGS. 2-3) isremoved and cut guide 100 is placed on k-wire 131, for example, suchthat wire 131 is received in a bore 208 of bores 108. If a cut angle isknown, cut guide 100 is placed onto two k-wires, such that the wires(e.g., wires 130) are received in bores (e.g., bores 108) of cut guide100. For example, a first k-wire (e.g., wire 131) may control alongitudinal position along a longitudinal dimension of first metatarsal122 and a second wire, such as a second k-wire 132 may be receivedthrough a second bore 209 of bores 108 to control a rotation of cutguide 100. Additional wires may be used to inhibit undesired positionaland rotational movement of cut guide 100 relative to the bones (e.g.medial cuneiform bone 121 and first metatarsal bone 122), includingupward drift.

Continuing to refer to FIGS. 1, and 4-11, if only one k-wire (e.g.,k-wire 131) is used to connect cut guide 100 to cut guide 100 may beused (e.g., rotated about k-wire 131) to establish a cut angle, asdesired by a surgeon. Cut guide 100 may be placed at a predeterminedposition with respect to the peaks and valleys of joint 204 such thatfirst cut slot 101 which may guide removal of bone from medial cuneiformbone 121 removes a minimal amount. Positioning cut guide 100 may be madeto, for example, remove a minimal amount of bone from first metatarsalbone 122, as well. A second k-wire (e.g., k-wire 132) may be connectedto cut guide 100 (e.g., via second bore 209) once a desired angle isestablished (e.g., as set by a surgeon).

Referring to FIGS. 4-7, the position of one hole/bore (e.g., bore 209)on cut guide 100 may be, for example, at an angle relative to a firstbore (e.g., bore 208). By inserting at least two k-wires (e.g., k-wire131 and k-wire 132) at angles to each other via bore 208 and bore 209,upward drift of cut guide 100 may be inhibited or prevented duringcutting. A third k-wire (e.g, a k-wire 133) may be connected through cutguide 100 to, for example, a lateral edge of first metatarsal bone 122.A final k-wire (e.g., a k-wire 134) may be placed into, for example, amedial aspect of first metatarsal bone 122, securing the k-wire tosecond member 103.

Still referring to FIGS. 7-10, mobile metatarsal cutting portion 103 maybe actuated using, for example, power screw 106. Other actuation meansmay be used to translate mobile metatarsal cutting portion 103 relativeto cut guide body 104. By actuating metatarsal adjustment screw 106, themetatarsal cutting portion 103 (e.g., distal metatarsal cutting slot 102thereof) of cut guide 100 is advanced distally. Distal advancement ofthe medial side of first metatarsal bone 122 while the lateral side isfixed places a moment on the metatarsal (e.g. first metatarsal bone122), causing an intermetatarsal angle 140 to decrease. As metatarsalcutting portion 103 advances distally, both proximal cuneiform cuttingslot 101, and distal metatarsal cutting slot 102 remain parallel.

Further referring to FIGS. 11-14, once intermetatarsal angle 140 angleis reduced to a desired angle and first metatarsal bone 122 is in adesired position, parallel saw cuts can be made using proximal cuneiformcutting slot 101 and distal metatarsal cutting slot 102. Both slots areparallel and are configured (e.g. shaped and dimensioned) to, forexample, remove more bone material from the lateral side of cuneiformbone 121 and the lateral side of first metatarsal bone 122. In anotherexample, cut guide 100 positioning is selected to remove material frommedial cuneiform bone 121 and first metatarsal bone 122 in parallelconfigurations with bone removal creating parallel surfaces for bonealignment (i.e. alignment of medial cuneiform bone 121 and firstmetatarsal bone 122), where such removal is necessary to correct theangle of obliquity. With reference to FIGS. 11-14, once the cuts havebeen made, cut guide 100 may be removed and the bones (i.e. medialcuneiform bone 121 and first metatarsal bone 122) brought intoapposition for placement of hardware. However, cut guide 100 may remainconnected to assist with hardware placement. By removing the k-wire onthe lateral edge of first metatarsal bone 122, power screw 106 may, forexample, be turned in the opposite direction, advancing mobilemetatarsal cutting portion 103 towards cut guide body 104 until bonesare in apposition and compression is applied.

Continuing to refer to FIGS. 11-14, cut guide 100 establishes the angleof the cuts prior to performing a cut and provides for parallel cuts tothe bones (e.g. medial cuneiform bone 121 and first metatarsal bone122), allowing medial cuneiform bone 121 and first metatarsal bone 122to be set at the desired angle. By establishing the angle prior toperforming the cut, joint correction is performed first. By doing so,intermetatarsal angle 140 is adjusted before the cut, and cut guide 100provides for two parallel cuts (e.g. one to medial cuneiform bone 121and one to first metatarsal bone 122) removing a fixed amount of bonebefore first metatarsal bone 122 is fused/connected to medial cuneiformbone 121 at the adjusted intermetatarsal angle. The bone surfaces afterthe cut are parallel and may be, for example, approximately flush whenfused. Since the bone was adjusted prior to the cut, fusion does notaffect the adjusted intermetatarsal angle (e.g., intermetatarsal angle140) and first metatarsal bone 122 remains positioned at the adjustedintermetatarsal angle.

Although the slots (e.g., cuneiform cutting slot 101 and distalmetatarsal cutting slot 102) are described above as being parallel toachieve parallel saw cuts, such slots may be substantially orapproximately parallel such that the bone surfaces of the bones (e.g.,first metatarsal bone 122 and medial cuneiform bone 121) to be fused areparallel enough after cutting via such slots to allow the fusion of thebones after the desired correction of the intermetatarsal angle (e.g.,intermetatarsal angle 140).

Cut guide 100 may be reversed so that the majority of medial bone isremoved from the cuneiform bone rather than the metatarsal bone.

In other embodiments, the initial k-wire hole may be a slot to allow forcustomization of cut depth.

The process of correcting frontal plane rotation occurs prior toplacement of distal k-wires.

While this invention has been described with respect to at least oneembodiment, the present invention can be further modified within thespirit and scope of this disclosure. This application is thereforeintended to cover any variations, uses, or adaptations of the inventionusing its general principles. Further, this application is intended tocover such departures from the present disclosure as come within knownor customary practice in the art to which this invention pertains andwhich fall within the limits of the appended claims.

We claim:
 1. A bone cut guide comprising: a first portion having a firstcut slot and having an aperture for receiving a wire to connect thefirst portion to a first bone; a second portion having a second cut slotand a second aperture for receiving a second wire to connect the secondportion to a second bone; the first portion and the second portionmovably connected to each other to allow the first bone and the secondbone to move relative to each other.
 2. The bone cut guide of claim 1further comprising a compression-distraction fixture connected to thefirst portion and the second portion for moving the first portionrelative to the second portion.
 3. The bone cut guide of claim 2 whereinthe compression distraction fixture comprises a screw engageable by auser and a rack engaging the screw to cause movement of the firstportion relative to the second portion.
 4. The bone cut guide of claim 3wherein the compression distraction fixture is configured to move thesecond portion distally away from the first bone in response to the useradvancing the screw.
 5. The bone cut guide of claim 4 wherein the movingthe second portion distally causes a distal advancement of a medial sideof the second bone and a lateral side of the second bone is held inplace by the second wire to cause an angle between the second bone and athird bone to decrease.
 6. The bone cut guide of claim 1 wherein thefirst portion comprises a third aperture to receive a third wire toconnect the first portion to the first bone to inhibit a rotation of thefirst portion about the first wire.
 7. The bone cut guide of claim 1wherein the first cut slot and the second cut slot have longitudinaldimensions substantially parallel to each other.
 8. The bone cut guideof claim 1 wherein the first portion comprises an arm having alongitudinal dimension aligned substantially parallel to a longitudinaldimension of the first bone when the first portion is connected to thefirst bone.
 9. The bone cut guide of claim 8 wherein the longitudinaldimension of the arm is aligned at a non-parallel angle relative to adirection of movability of the first portion relative to the secondportion.
 10. A method for use in aligning bones, comprising: inserting ajoint arm of a guide between a first bone and a second bone; inserting afirst wire through a guide aperture of the guide into the first bone;removing the guide from the first bone and the first wire; attaching afirst portion of a bone cut guide to the first bone by receiving thefirst wire in a first aperture of the bone cut guide; and attaching asecond portion of the bone cut guide to the second bone by receiving asecond wire in a second aperture of the bone cut guide and inserting thesecond wire in the second bone.
 11. The method of claim 10 furthercomprising receiving a third wire in a third aperture of the firstportion to connect the first portion to the first bone to inhibit arotation of the first portion about the first wire.
 12. The method ofclaim 10 further comprising moving the first portion and the secondportion relative to each other to adjust an angle of a longitudinaldimension of the first bone relative to a second longitudinal dimensionof the second bone.
 13. The method of claim 10 further comprising movingthe first portion and the second portion relative to each other toadjust an angle of a longitudinal dimension of the second bone relativeto a second longitudinal dimension of a third bone.
 14. The method ofclaim 10 further comprising cutting the first bone through a firstcutting slot of the first portion and cutting the second bone through asecond cutting slot of the second portion wherein the first cut slot andthe second cut slot have longitudinal dimensions substantially parallelto each other.
 15. The method of claim 10 further comprising moving thefirst portion and the second portion using a compression-distractionfixture connected to the first portion and the second portion for movingthe first portion relative to the second portion.
 16. The method ofclaim 15 wherein the moving the first portion and the second portioncomprises a user advancing a screw of the compression-distractionfixture to engage a rack to cause the second portion to distally moveaway from the first bone.
 17. The method of claim 16 wherein the movingthe second portion distally causes a distal advancement of a medial sideof the second bone and a lateral side of the second bone is held inplace by the second wire to cause an angle between a longitudinal axisof the second bone and a longitudinal axis of a third bone to decrease.18. The method of claim 10 further comprising aligning a longitudinalaxis of a longitudinal dimension of a first arm of the first portionsubstantially parallel to a longitudinal axis of a longitudinaldimension of the first bone.
 19. The method of claim 10 wherein theinserting the joint arm of the guide between the first bone and thesecond bone comprises the joint arm of the joint guide contacting thefirst bone to align the guide to locate the guide aperture and the firstwire, and further comprising rotating the cut guide about the wire to adesired position of the second bone or the first bone relative to athird bone.
 20. The method of claim 19 further comprising receiving athird wire in a third aperture of the first portion to connect the firstportion to the first bone to inhibit a rotation of the first portionabout the first wire.